PracticeUpdate: Conference Series | ADC 2018

Comment ADDN: Facilitating Research and Benchmarking to Improve Diabetes Care INTERVIEW WITH PETER COLMAN MBBS, FRACP, MD

Dr. Peter Colman

" There are newer types of medication and technology, but there are also things we can do systematically across states and clinics in terms of how we actually deliver care to our patients that will ultimately help improve outcomes. " could potentially feed data into ADDN are the EXTEND (tocilizumab in T1D) and ENDIA (Environmental Determinants of Islet Autoimmunity) clinical trials, as well as TrialNet. Registry also reveals that a large proportion of patients with T1D struggle to reach glycemic targets Less than a third of children and adults with T1D in Australia are achieving target glycemic control, latest data from the ADDN registry reveal. Data released in the March 2018 benchmarking report showed that, among 4791 children and adolescents with T1D, only 14% (n=661) achieved HbA1c <7.0% while 44% (n=2107) had HbA1c between 7.5 and <9.0% and 23% (n=1119) ≥9.0%. Mean HbA1c was 8.3%. Among 1760 adults with T1D, 14% (n=254) had HbA1c <7.0%, while 28% (n=489) had HbA1c between 7.5% and <9.0% and 23% (n=399) ≥9.0%. Mean HbA1c was 8.4%. “We know that a patient’s outcome, in terms of developing microvascular and macrovascular complications, is better when their HbA1c is less than 7%. However, the reality is that many of our patients with type 1 diabetes do not achieve that,” Dr. Colman said. “The question then is ‘how do we address this?’” Dr. Colman said analysis of the ADDN registry data will help the continuous and long-term assessment of treatment pathways and inform changes in guidelines and health policy. “There are newer types of medication and technology, but there are also things we can do systematically across states and clinics in terms of how we actually deliver care to our patients that will ultimately help improve outcomes,” he added.

Dr. Colman is Principal Investigator of the ADDN Study Group, and an Endocrinologist at the Department of Diabetes and Endocrinology at Royal Melbourne Hospital in Melbourne, Australia. T he ADDN is a very well-designed database that provides information across the country on how we’re doing when it comes to look- ing after people with T1D. It was initially set up as a register that would collect people with T1D for clinical trials. Over time – and it’s now into its second phase – while clinical trials are still a focus, it’s become an important registry for looking at benchmarking and quality of care data provided by diabetes centres across the population of people with T1D. It gives us the ability to look at patient outcomes from the time of diagnosis in childhood or early adulthood through to their adult life, and to look at the devel- opment of complications. The ADDN is the only registry of its kind in Australia. We can now tell, for instance, the percentage of people on insulin pumps or on multi-dose insulin, and then compare the information across centres nationally and internationally. We know that we have fewer people on insulin pumps in Australia compared with the US or Europe. And while the average HbA1c in our T1D population is probably better than that in the US, it’s not as good as data coming out of Austrian or Swedish registries. But we know, with a certain level of confidence, that we’re tracking close to these international centres in terms of glycemic control. The other important aspect of the ADDN is that it’s a resource for the whole community. Its main purpose is to improve the care and outcomes of people with diabetes, and to stimulate research. ADDN data are essentially available to any researcher.

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ADC 2018 • PRACTICEUPDATE CONFERENCE SERIES